Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients

Julia B. Greer, Phil Greer, Bimaljit S. Sandhu, Samer Alkaade, C. Mel Wilcox, Michelle A. Anderson, Stuart Sherman, Timothy B. Gardner, Michele D. Lewis, Nalini M. Guda, Thiruvengadam Muniraj, Darwin Conwell, Gregory A. Cote, Christopher E. Forsmark, Peter A. Banks, Gong Tang, Kim Stello, Andres Gelrud, Randall E. Brand, Adam SlivkaDavid C. Whitcomb, Dhiraj Yadav

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Chronic pancreatitis (CP) patients frequently experience malabsorption and maldigestion, leading to micronutrient and macronutrient deficiencies. Comorbid diabetes and lifestyle habits, such as alcohol consumption, may impact nutrition status. Methods: We compared micronutrient antioxidant, bone metabolism, serum protein, and inflammatory marker levels in 301 CP patients and 266 controls with no known pancreatic disease. We analyzed serum prealbumin and retinol binding protein; vitamins A, D, E, and B12; osteocalcin; tumor necrosis factor-α; and C-reactive protein (CRP). We also evaluated biomarkers among subsets of patients, examining factors including time since diagnosis, body mass index, alcohol as primary etiology, diabetes mellitus, vitamin supplementation, and pancreatic enzyme replacement. Results: After correcting for multiple comparisons, CP patients had significantly lower levels than controls of the following: vitamin A (40.9 vs 45.4 μg/dL) and vitamin E (α-tocopherol [8.7 vs 10.3 mg/L] and γ-tocopherol [1.8 vs 2.2 mg/L]), as well as osteocalcin (7.9 vs 10 ng/mL) and serum prealbumin (23 vs 27 mg/dL). Both patients and controls who took vitamin supplements had higher serum levels of vitamins than those not taking supplements. Compared with controls, in controlled analyses, CP patients had significantly lower levels of vitamins A, D, and E (both α-tocopherol and γ-tocopherol). CP patients also had significantly lower levels of osteocalcin, serum prealbumin, and retinol binding protein, and higher CRP. Conclusions: CP patients demonstrated lower levels of selected nutrition and bone metabolism biomarkers than controls. Diabetes and alcohol did not impact biomarkers. Vitamin supplements and pancreatic enzyme replacement therapy improved nutrition biomarkers in CP patients.

Original languageEnglish (US)
JournalNutrition in Clinical Practice
DOIs
StateAccepted/In press - Jan 1 2018

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Keywords

  • chronic pancreatitis
  • inflammation
  • malabsorption
  • micronutrient deficiency
  • pancreatic enzyme replacement therapy
  • steatorrhea

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Greer, J. B., Greer, P., Sandhu, B. S., Alkaade, S., Wilcox, C. M., Anderson, M. A., Sherman, S., Gardner, T. B., Lewis, M. D., Guda, N. M., Muniraj, T., Conwell, D., Cote, G. A., Forsmark, C. E., Banks, P. A., Tang, G., Stello, K., Gelrud, A., Brand, R. E., ... Yadav, D. (Accepted/In press). Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients. Nutrition in Clinical Practice. https://doi.org/10.1002/ncp.10186